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Saturday, February 22, 2014

Dental surgery strikes fear into the heart of humans everywhere and has since the beginning of recorded time. When I was a kid I was one of those fearful people, and I might add, with reason. I grew up under the auspices of socialized medicine during my years at an English boarding school. It was in post World War Two Europe at a time when the capitalists of the west felt an obligation to be kind to their people to prove to the communists of the east that they weren't the greedy oligarchs they have since proved themselves to be. As a result I got excellent free medical and dental care as and when needed including home visits by a family doctor, all vaccinations and teeth filled with no bills, no company's, no arguing with insurance company bureaucrats. We got the medical care the medical professionals deemed we needed, with no lawyers lawsuits or refused coverage. On that subject my dentist was according to dentists who inspected his work later in my life, workmanlike if not pretty. But I'll tell you what, Dr Calvert instilled a holy terror of dentists in my young life. Free or not that man exacted a price with his National Health Service drill.

These days modern American dentists numb up your gums with gentle, gradually more powerful cocaine-derived injections that leave your face feeling like an Easter Island moai . In those days when I needed a filling Dr Calvert got in there like an enthusiastic road mender with a jackhammer.mto no avail my wriggles or screams for mercy. He drilled until he had the hole he needed. It was aversion therapy of the most brutal sort; tough love that kept me away from dentists for a decade. Then when at last I tired of feeling holes in my teeth I approached my first American fee-for-service dentist in California.

That reversed the trend of my youth. I had a dentist who cured what ailed me, didn't hurt me and allowed me to spread my payments as monthly charges to make it all affordable. I lost my fear of dentistry. Then one day I got a note telling me my dentist had died and I had to rebuild my relationship with his replacement. Imagine my shock when I discovered that gentle man who had taught me not to fear the drill had decided to connect the exhaust of his car to the passenger compartment and took his own life. He had helped me make my life pain free but his own pain he apparently could not handle. That shook me up.

I suppose one has to admit that with advancing age one does tend to look around and wonder what medical services you can find in a small town on a small speck of land in the middle of a gorgeous blue ocean. The short answer is not bad and getting better as Key West gentrifies. Besides, Miami isn't very far away and they have world class facilities there to keep you alive if you can afford them. So it should come as no surprise that I easily found a fine dental office with lots of novocaine and a policy of taking my city insurance policy.

Thus far it's a fairly standard story of middle class dentistry, me who has lost my fear of the chair, would make six monthly appointments for cleaning and checking, and my dentist a cheerful eccentric who takes pleasure in his work, and all was well with the world. Especislky as it turns out I have been fortunate to get strong dental genes. In adulthood my tooth problems have been minor, not even many fillings over the years. My cleanings, free through my insurance, are perfunctory as I floss and brush regularly and my only artificial tooth was a front tooth knocked out in a mountain biking accident 25 years ago in California's SabtaCruz mountains.

Last year a molar that had been dying finally had to come out and it was with fascination I followed along as my dentist pulled the brown dead stub and the pain in my jaw went away even as the ever-necessary novocaine wore off. "We'll do the other half after the new year so you get the full insurance benefit for each calendar year" he said as I put down my $200 co-pay. That also gave the hole time to heal before he put in the artificial replacement. And so it was with breezy cheerfulness I returned last week to start the process anew.

Thanks to my lack of fear, for me going to the dentist is a chance to relax and read while stuck in the chair, then I get to chat with the dentist who shares my eccentric and inappropriate sense of humor. I listen to him gossip with his assistant and I have been known to drift off to sleep as they set forms in my jaw or take measurements. I awoke from this pleasant nirvana with a shock, as breath taking as a cold shower when I emerged to talk yo the scheduler to to make my copayment. "That will be twenty eight hundred and forty dollars please," she said as though she expected me to produce a wad of cash like a mobster. I stood there like an idiot. I expected the other half of the bill to resemble the first but she went on with a steely flint in her eye: "We expect fifty percent immediately" literally holding out her hand. I pushed forward my credit card feeling like I was getting raped and wondering what my wife would say when I told her I needed to crank, seriously on the overtime. I wandered out in a daze. Apparently the two "halves" of my treatment were slightly, ever so slightly, mismatched.

I am as they say slow to anger but when the resentment has built up, out of sight in my chest, and fermented for a while in my head, I get into towering rages and they usually come as a surprise to people who don't see the inner symptoms. I am not very good at expressing building irritation but when it does surface it incinerates anything in its path. As was the case here as I slowly and inexorably decided this sort of bill paying scheme was pissing me off royally. I already have a permanent burr up my butt about our medical system that feeds insurers first, providers second and slices a pound of flesh off us the customers. Among all the many right wing critics of the Affordable Care Act I have yet to hear one with any idea of how to improve it and expand the small gains it makes for us the consumers. The idea of going back to the hell of an open market place where insurance companies raped us, denied service at random and excluded anyone with an illness is too awful to contemplate. Not that the situation right now is brilliant but it is marginally better.

Funnily enough my dentist had been on vacation in Thailand of all places where he slipped in the shower and broke his arm. World class treatment for this break was a big far zero and he ended up paying just seventy bucks for pain killers on prescription. Cheers all round I thought at the time then suddenly here I was in the jaws of an inexorable medical system that suddenly sticks me, without warning, with thousands of dollars in fees and my dentist, my former champion of single payer, is sticking it to me! What The Fuck? I guess the office was surprised when I spoke by phone explaining I was burnt out on this method of extracting fees by stealth and would they mind if I dropped them and found another dentist to finish the treatment? This after three days of agitation and self recrimination and getting all stressed out and giving myself a head cold. Yup I guess I should have spoken up but I thought we were splitting the costs in half to get maximum insurance coverage? Apparently not, it was in point of fact a one fifth - four fifths split. A bit of a surprise.

After my phone blow up the tension drained from me, just like a drained abscess and I started sleeping again. Then I got a call back from the dentist himself. I was a bit anxious but he immediately broke into an abject apology about the whole mess and everything was changing in his office now thanks to this mess and everyone will get a written estimate of charges generated by their next appointment. "Thanks to you," my dentist said, "we are revamping all our office procedures so this will never happen again.Thank you for speaking up." Completely weird having a love in with my dentist over the phone but it really did happen. He personally made an appointment for my follow up x-ray on Monday and now I face the prospect of going into the office and facing all these people I got really annoyed at. I believe I was justified and I never totally lost my shit on them, but still...it's all rather embarrassing. Exactly what you don't want to do in a small town!

I think I would rather deal with Dr Calvert and his novocaine-free socialized drill, than have to walk into the dental office I have turned upside down with my temper tantrum. After all these years I am nervous once again about going to the dentist.

Key West Diary

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